Transcript schools

Medical Exemptions
and
School Nurse Module
Jeffrey Neccuzi, Director
WV Division of Immunization Services
January 14, 2015
School Immunization Requirements
•
School immunization requirements
have played a major role in
controlling vaccine-preventable
diseases (VPDs) among school
children
•
All states and the District of
Columbia require children entering
school to provide documentation
that they have met the state vaccination requirements
•
This model for elimination and control of VPDs exists all over the
world
1
Medical/Nonmedical Exemptions
Although immunizations are required for school entry, most states
offer nonmedical exemptions (religious or personal belief)
• All states allow medical exemptions to
school and daycare immunization
requirements
• 48 states allow religious exemptions
• 19 states have a provision for personal
belief exemptions
2
WV Medical/Nonmedical Exemptions
• WV does not grant personal or
religious exemptions
• WV is one of only two states that
allow only medical exemptions to
school immunization
• Non-medical exemptions have been
associated with increased occurrence
of serious diseases spread by sick
school children
3
Historical Review
WV School Immunizations 1987-2013
1987:
WV State Code 16-3-4
• Compulsory immunization of school children
Sets specific vaccine requirements for all children entering
school for first time. Covers six diseases:
• Diphtheria, Polio, Measles, Rubella, Tetanus and Pertussis
2008:
WV code of state rules 64CSR95
• Three additional vaccines are added for school admission:
• Varicella, Hepatitis B, Mumps
2011:
WV code of state rules 64CSR95
• Adds two adolescent vaccines:
• Tdap & MCV
4
State Code – Compulsory Immunization
§64-95-4
All students attending a West Virginia school for the first
time shall show proof of immunization against the
following diseases:
Diphtheria
Rubella
Hepatitis B
Rubeola (Measles)
Mumps
Tetanus
Pertussis (Whooping Cough)
Varicella (Chickenpox)
Poliomyeltis
5
State Code – Compulsory Immunization
§64-95-8
Vaccine requirements for adolescents
Effective June 1, 2012, and prior to the beginning of the school
year 2012 – 2013, Tdap and MCV4 vaccines became required for
children attending middle and high schools in West Virginia
Proof of vaccination shall be presented upon entry to the 7th and
12th grades, as indicated
Tdap: One dose before 7th or 12th grade entry
Meningococcal: One dose before 7th grade entry; 2nd (booster, age
appropriate) dose required before 12th grade entry
6
Exemptions by State
7
Medical Exemption Requests
§64-95-10 Medical Exemptions
The provisions of this rule may
not apply if a child has a valid
medical contraindication or
precaution to a particular vaccine
Medical exemption request must be from a
physician who has treated or examined the
child and submitted to the local health
officer in the county where the child will
attend school
8
Valid Medical Exemption
Conditions which constitute a valid medical exemption
Weakened immune system due to a permanent or temporary
condition – e.g. certain diseases, medications, cancer,
chemotherapy, radiation treatment, etc.
Severe allergy to a vaccine component
Serious adverse event associated with a previous vaccination
9
Medical Exemption Requests - cont.
The physician’s request for exemption from immunization
shall state specifically:
which vaccine or vaccines the child should be exempt
from receiving
an explanation of the medical contraindication or
precaution relied upon to make the request
whether the exemption is permanent or temporary
10
Invalid Medical Exemption Requests
Examples of Invalid Exemptions
Use of experimental
or unlicensed
products to provide
immunization
Family has history of
vaccine reactions
Requests which incorporate
philosophical and religious
objections to immunization
Common, nonserious side effect
to a previous
vaccination
Parental anxiety/adherence
to “slow” vaccine schedule
and any other reasons not
supported by current
medical standards
11
Medical Exemptions Process
1.
Requests for
medical
exemption from
vaccine
requirements shall
be reviewed and
approved or
denied initially by
the local health
officer in the
county where the
requestor attends
school
3.
2.
Approval or denial
of a request shall
be in writing and a
copy of the
response shall be
sent to the State
Health Officer
Local health officials
shall verify that
immunization
exemptions are
entered into the West
Virginia Statewide
Immunization
Information System -WVSIIS-- to enable
support of individuals
at increased risk of
disease in an outbreak
and to aid in disease
control and
surveillance (10.4)
12
Medical Exemptions Process - cont.
4.
5.
6.
The local health
officer’s decision
on a request for a
medical
exemption from
immunization
may be reviewed
by the State
Health Officer
The request for
state level
review and the
State Health
Officer’s
decision on such
requests shall
be in writing
Decisions of
the State
Health Officer
may be
appealed as
described in
procedural rule
64CSR1
13
Medical Exemptions Process cont.
All requests for medical
exemption from immunization
shall be reviewed.
Determinations are based on
current medical science and
recommendations from the:
- Advisory Committee on
Immunization Practices (ACIP)
- American Academy of
Pediatrics (AAP)
- American Academy of Family
Physicians (AAFP)
10.7.
14
Importance of Tracking Medical Exemptions
• To enable public health to
quickly identify children in
our schools who have a
medical exemption so
they may be excluded until
The outbreak is over
• To track the number and
type of medical exemptions
15
Importance of Tracking Medical Exemptions cont.
• To ensure that medical exemptions
are not requested/obtained because
they the are the only type of
exemption available
• To report medical exemption data to
the public or legislature when
requested
16
View/Add Screen
17
Exemption Request Button
18
Required Fields
19
LHO Approval Screen
20
Request Section (Blank)
21
Demographics Completed
22
Exemption Details
23
Exemption Request Summary
24
Exemption Acknowledgement
25
Exemptions Tracking Page
26
WVSIIS School Nurse Module

WVSIIS and its role in public health

Benefit to the school nurse

Why report to the registry

Entering historical vaccination records

Available reports
WVSIIS (WV Statewide Immunization Information System)
WVSIIS is a confidential, population-based,
computerized database that can record all
immunization doses administered by participating
providers to persons within WV
At the Point of Clinical Care
WVSIIS . . .
 provides consolidated immunization histories for use
by the vaccination provider in determining appropriate
vaccinations for patients
At the Population Level
WVSIIS . . .
 provides aggregate data on vaccinations for use in
surveillance and program operations
 guides public health action with the goals of improving
vaccination rates and reducing vaccine-preventable
diseases
For the School Nurse
WVSIIS . . .
 gives convenient access to student immunization and
forecast records
 gives the ability to enter historical vaccinations
 gives the availability of additional school nurse
module reports
School Nurse Module
Purpose
 The school nurse module provides school nurses
special access to the immunization REGISTRY and to
allow the ability to create school specific reports in
order to manage student immunization coverage
32
School Nurse Module
 The school nurse module features an abbreviated
demographic screen where users can view
demographic data and immunization history contained
in the registry
 Users may add new students, update the student’s
demographic data, and add historical immunizations
33
Why Report Vaccinations to the Registry?
• WVIIS provides easy access to patient immunization
records
• Supports efforts to improve patient coverage rates
within the state
• Enables healthcare providers to make appropriate
clinical decisions based on accurate data in the
registry
Historical Vaccinations
• WVSIIS is the official repository of WV immunization
records
• Historical vaccination entry is a way to ensure that the
student’s vaccination record is complete in WVSIIS
• School nurses are an invaluable resource for obtaining
complete immunization histories and entering missing
shot records as needed
Entering Historical Vaccination Records
Entering Historical Vaccination Records
• Entering historical vaccination records is a simple
process that goes beyond the traditional ‘view only’
access for school nurses
• Entry of missing vaccinations will help complete the
shot record for the student which will enable the
school and health professional easy access to complete
and accurate vaccination records
37
Selecting A School
• When logging into the school nurse module, you see a slightly
different format that requires you to select the school the
student attends
• To select a school, click on ‘click to select’
Selecting A School
• Click on ‘search’ and select school from the list
39
Selecting A School
• After selecting the school, click ‘continue’
40
Selecting A Student
Next, select the student.
• Fill in the search criteria and click on ‘search’
• Choose the correct student from the search results
41
Selecting A Student
• Check the ‘include on reports’ box and click ‘update’
• This will assign the student to the appropriate school for
report purposes
42
Adding A Student
• If your search does not find the student you are looking for, you
may add the student by checking the ‘check here if adding a new
patient’ box. The required fields will be highlighted in red
43
Adding A Student
• After information is entered, click ‘add patient’
44
Editing Student Demographics
• To change the address or phone number for a selected
student click ‘edit’
45
Editing Student Demographics
• Enter the new information and click ‘save’
46
Entering A Historical Vaccination
• To add a historical vaccination, under the vaccinations menu
on the left, click on ‘view/add’
• Enter the date the vaccination was administered in the box
beside the correct vaccination
ENTERING A HISTORICAL VACCINATION
• AFTER ENTERING THE VACCINATION DATE, SCROLL DOWN
AND CLICK ON ‘ADD HISTORICALS’
48
Available Reports
Vaccination Forecast
The Vaccination Forecast Report is a tool utilized to show the
future dates that the patient will need to be vaccinated according
to the ACIP schedule. It can be used to determine at a glance if the
student is missing necessary immunizations.
• The forecast can also be used to determine when a provisional
school enrollment period should expire
• BPH recommends adding 15 days to the date of when the last
forecasted, required immunization is due
Vaccination Forecast
• Under the vaccinations menu, click on ‘forecast’
• This shows the vaccinations that are still due or overdue for the
student
• This report should be viewed only after the missing historical
vaccinations are entered
Vaccination Summary
• The Summary Patient Record report shows all vaccinations that
have been recorded in the registry. The date and dose are listed
along with the age it was administered.
• If the student’s recorded vaccinations are up-to-date in the
registry, the report shown will be an accurate account of the
vaccinations given and will also show future vaccinations due for
the selected student.
Vaccination Summary
• Under the vaccinations menu, click on summary
• This report should be viewed only after the missing historical
vaccinations are entered
School Nurse Reports
•
•
•
•
School immunization report, first time enterer
Summary of school enterers data
Patient detail
Absentee report
*Note: these reports will only be valuable if all students have
been assigned to a school roster
Adding Students To School Roster
• From the schools menu, click on ‘roster’ and choose vaccination
series
• Click on ‘view roster’
55
Adding Students To School Roster
• Click on ‘add new students’
56
Adding Students To School Roster
• From the patient menu, click on ‘search/add’ and choose patient
• Check the box ‘include on school reports’, and click on ‘update’
• Repeat for each student
57
School Nurse Reports
• From the ‘reports’ menu on the left, click on ‘school reports’ and
choose the report you wish to run
• You will see the following screen:
58
School Immunization, First Time Enterer
• This report can be produced for new students you have assigned
to a school.
• It can show the number of students needing vaccinations or
which students have completed vaccinations.
School Immunization, First Time Enterer
• From the ‘reports’ menu on the left, click on ‘school reports’ and
choose ‘school immunization report, first time enterers’
• Click on ‘needing vaccination’ or ‘completed vaccination’ bubble
and click on ‘create report’
60
School Immunization, First Time Enterer
This report will show the number of incomplete or complete
records for students added to the school roster
61
Summary of School Enterers Data Report
• From the ‘reports’ menu on the left, click on ‘school reports’ and
choose ‘summary of school enterers data’
• Choose vaccination series
• Click on ‘select’
62
Summary of School Enterers Data Report
• This report will show the percentage of incomplete or complete
records for students added to the school roster
63
Patient Detail Report
• From the reports menu, click on ‘school reports, and choose
‘patient detail report’
• Select school
Patient Detail Report
• This report will show the vaccination records for the students
that have been added to the school roster
Tracking Absenteeism
The number of students absent each day can be tracked
and a report can be produced
to show the number of absentee days
for a specific time period
Tracking Absenteeism
•
•
•
•
From the ‘schools’ menu, click on ‘absenteeism’
Enter date or date period you will be entering absentee days for
Click ‘add’
Enter the number of students absent for that date or date period
and click ‘save’
67
Absentee Report
• Under the ‘reports’ menu, click on ‘school reports’ and select
‘absentee report’
• Enter the period of absentee days you want to view and click on
‘create report’
Helpful Resources On Homepage
•
School Nurse Module Power Point Presentation
•
WVDIS Website
• ACIP immunization schedules
• Childcare, school, and college requirements
• Vaccine-preventable diseases
Verification Of Training
In order to acknowledge you have completed this training
and to request access to the school nurse module in WVSIIS,
please click on the link below:
Training Verification Survey
Points Of Contact
Jeff Neccuzi - Division of Immunization Services (WVDIS) Director
Jean Khoury - WVDIS (Consultant for Accelerated Vaccine
Schedules, Minimum Intervals, etc.)
Sarah Lieu
- WVDIS Public Information Specialist
304-558-2188 OR 1-800-642-3634
Pam Reynolds - WVSIIS Information Quality Services Coordinator
304-356-4048
Carol Smith – WVSIIS Information Quality Services Specialist
304-356-4945
Becky Pierson – WVSIIS Help Desk Analyst
877-408-8930 or 304-356-4047